In the United States, the population over 65 years of age is expected to reach 88 million by 2050.3 With “aging” being the primary risk factor for the development of cognitive impairments, it is safe to assume that the number of individuals diagnosed with dementia, Alzheimer’s disease, etc. will also increase exponentially.3 Caregivers of patients with cognitive impairments, such as physical therapist, should be educated on the most effective treatment strategies for reducing or attenuating the effects of cognitive decline. The following information will focus on the effects of various exercise and cognitive interventions to determine the most beneficial treatment strategies for patients with cognitive impairments.
Cognition-based programs have already been shown to be an effective treatment strategy in individuals with mild cognitive impairment, and mild and moderate Alzheimer’s disease.4 Unfortunately, interventions involving cognitive-based therapy should be intensive and gains may take between 6 months and 1 year to be observed.4
Physical exercise may be a supplement to cognitive-based therapy. Schwenk et al observed improvements in gait speed, cadence, stride length and time, and double support in participants with mild-to-moderate dementia who participating in 3 months of strength and functional training.5 Supervised resistance training (70-80% of 1RM) and functional training were performed 2x/week for 2 hours.5 Although gains were made in physical fitness, it is difficult to say how this type of physical activity affected cognition since researchers did not measure cognitive performance in this study.
Physical and cognitive effects of exercises were assessed in a study performed by Bosser et al on 33 long-term care dementia patients. Interestingly, when resistance training was combined with aerobic exercise, it showed no significant cognitive preservation over patients participating in a social group.1 Compared to Schwenk et al, this study utilized a higher frequency (5x/week, 30 min/session) but a shorter duration (6 weeks).1,5 A lack of cognitive gains could be attributed to low adherence rate (46.2%) in the exercise group versus the social group (86.3%).1 Improvements were observed in walking speed, 6-minute walk test times, and isometric
From the previously mentioned data, one can speculate that the most effective intervention for maintaining physical and cognitive performance in patients with dementia is an intervention that combines both physical and cognitive tasks. Yoon et al observed significant improvements in balance, gait, memory and quality of life in dementia patients who performed cycling exercise and sequential memory recall tasks over those patients who only participated in conventional physical therapy alone.6 The experimental group performed 30 additional minutes of physical activity 3x/week for 12 weeks.6
Resistance training is one of the most important components for maintaining functional abilities in patients with cognitive impairments. Cadore et al performed 4 weeks of walking, balance, and cognitive exercise, then added 4 additional weeks of strength training (8-12 repetitions; 20-50% of 1RM) with walking, balance and cognitive exercise in 18 frail patients with mild dementia.2 The addition of progressive resistance training proved to be substantially more beneficial in fall reduction and timed up and go score (as well as strength components measured) when compared to aerobic, balance, and cognitive tasks alone. Unfortunately, no cognitive improvements were observed from this intervention.2
From the data presented, it is clear that treatment interventions for patients with cognitive impairments should include both physical and mental challenges. Additionally, a mixture of progressive resistance training, balance, and aerobic training should be utilized to maximize the benefits of the intervention program. Intensity should be between moderate and vigorous in order to make the most gains and the program should last a minimum of 3 and 6 months. The usage of outcome measures prior to, throughout, and following the completion of the intervention program is important in order to most accurately assess how effective the program is at treating patients with cognitive impairments. Maintenance is also an important aspect of interventions in patients with dementia. Gains made by an intervention program were complete lost at 24 weeks after cessation of the exercise program.2 Therefore, it is important to establish a maintenance program with the patient’s caregiver or institution in order to reduce or attenuate the physical and mental decline associated with dementia. For more information on cognitive impairments, please visit http://www.alz.org/what-is-dementia.asp.
References
1) Bosser, W. et al. “Feasibility of a combined aerobic and strength program and its effects on cognitive and physical function in institutionalized dementia patients. A pilot study.” (2014) PLoS ONE 9(5).
2) Cardore, E. et al. “Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint.” AGE (2014) 36(801-811).
4) Olarazan, J. et al. “Benefits of cognitive-motor intervention in MCI and mild to moderate Alzhemier’s disease.” (2004) Neurology 63(12).
5) Schwenk, M., Zieschang, T., Englert, S., Grewal, G., Najafi, B., Hauer, K. “Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomized controlled trial.” (2014) BMC Geriatrics 14(73).
6) Yoon, J. et al. “The effects of cognitive activity combined with active extremity exercise on balance, walking activity, memory level and quality of life of an older adult sample with dementia.” (2013) Journal of Physical Therapy Science 25(1601-1604).
Cognition-based programs have already been shown to be an effective treatment strategy in individuals with mild cognitive impairment, and mild and moderate Alzheimer’s disease.4 Unfortunately, interventions involving cognitive-based therapy should be intensive and gains may take between 6 months and 1 year to be observed.4
Physical exercise may be a supplement to cognitive-based therapy. Schwenk et al observed improvements in gait speed, cadence, stride length and time, and double support in participants with mild-to-moderate dementia who participating in 3 months of strength and functional training.5 Supervised resistance training (70-80% of 1RM) and functional training were performed 2x/week for 2 hours.5 Although gains were made in physical fitness, it is difficult to say how this type of physical activity affected cognition since researchers did not measure cognitive performance in this study.
Physical and cognitive effects of exercises were assessed in a study performed by Bosser et al on 33 long-term care dementia patients. Interestingly, when resistance training was combined with aerobic exercise, it showed no significant cognitive preservation over patients participating in a social group.1 Compared to Schwenk et al, this study utilized a higher frequency (5x/week, 30 min/session) but a shorter duration (6 weeks).1,5 A lack of cognitive gains could be attributed to low adherence rate (46.2%) in the exercise group versus the social group (86.3%).1 Improvements were observed in walking speed, 6-minute walk test times, and isometric
From the previously mentioned data, one can speculate that the most effective intervention for maintaining physical and cognitive performance in patients with dementia is an intervention that combines both physical and cognitive tasks. Yoon et al observed significant improvements in balance, gait, memory and quality of life in dementia patients who performed cycling exercise and sequential memory recall tasks over those patients who only participated in conventional physical therapy alone.6 The experimental group performed 30 additional minutes of physical activity 3x/week for 12 weeks.6
Resistance training is one of the most important components for maintaining functional abilities in patients with cognitive impairments. Cadore et al performed 4 weeks of walking, balance, and cognitive exercise, then added 4 additional weeks of strength training (8-12 repetitions; 20-50% of 1RM) with walking, balance and cognitive exercise in 18 frail patients with mild dementia.2 The addition of progressive resistance training proved to be substantially more beneficial in fall reduction and timed up and go score (as well as strength components measured) when compared to aerobic, balance, and cognitive tasks alone. Unfortunately, no cognitive improvements were observed from this intervention.2
From the data presented, it is clear that treatment interventions for patients with cognitive impairments should include both physical and mental challenges. Additionally, a mixture of progressive resistance training, balance, and aerobic training should be utilized to maximize the benefits of the intervention program. Intensity should be between moderate and vigorous in order to make the most gains and the program should last a minimum of 3 and 6 months. The usage of outcome measures prior to, throughout, and following the completion of the intervention program is important in order to most accurately assess how effective the program is at treating patients with cognitive impairments. Maintenance is also an important aspect of interventions in patients with dementia. Gains made by an intervention program were complete lost at 24 weeks after cessation of the exercise program.2 Therefore, it is important to establish a maintenance program with the patient’s caregiver or institution in order to reduce or attenuate the physical and mental decline associated with dementia. For more information on cognitive impairments, please visit http://www.alz.org/what-is-dementia.asp.
References
1) Bosser, W. et al. “Feasibility of a combined aerobic and strength program and its effects on cognitive and physical function in institutionalized dementia patients. A pilot study.” (2014) PLoS ONE 9(5).
2) Cardore, E. et al. “Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint.” AGE (2014) 36(801-811).
3) “Dementia: Hope Through Research.” The Institute of Neurological Disorders and Stroke. Accessed on July 8, 2015. Last updated on February 23, 2015.
http://www.ninds.nih.gov/disorders/dementias/detail_dementia.htm
4) Olarazan, J. et al. “Benefits of cognitive-motor intervention in MCI and mild to moderate Alzhemier’s disease.” (2004) Neurology 63(12).
5) Schwenk, M., Zieschang, T., Englert, S., Grewal, G., Najafi, B., Hauer, K. “Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomized controlled trial.” (2014) BMC Geriatrics 14(73).
6) Yoon, J. et al. “The effects of cognitive activity combined with active extremity exercise on balance, walking activity, memory level and quality of life of an older adult sample with dementia.” (2013) Journal of Physical Therapy Science 25(1601-1604).